Basic Information
| Provider Information | |||||||||
| NPI: | 1740555960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSSAKOWSKI | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 S EMERY AVE | ||||||||
| Address2: | |||||||||
| City: | PESHTIGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541571526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087809515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2360 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559064065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072820142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2012 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 13338-40 | WI | N | Pharmacy Service Providers | Pharmacist | 183500000X | 20307 | IA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 116066 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.